Shang-Lin Chiang

Isokinetic muscle strength of the trunk and bilateral knees in young subjects with lumbar disc herniation.

Study Design. Cross-sectional study comparing normal subjects and patients with lumbar disc herniation. Objective. To evaluate trunk and knee muscle strength in patients with L4–L5 and/or L5–S1 disc herniation. Summary of Background Data. Numerous studies have shown that patients with low back pain have weaker trunk muscles. The strength of trunk and knee muscles has not been investigated simultaneously in patients with lumbar disc herniation. Methods. Forty-one controls and 2 patients were included. Isokinetic strength of the trunk and bilateral knees was tested on a calibrated isokinetic testing machine (Biodex System 3 Pro) regardless of the laterality of the radiculopathy. The testing was carrying out at two different velocities: 60° and 120° per second. Results. Total trunk strength and knee strength were significantly lower in these patients (4.34 ± 1.06 and 4.06 ± 1.16 vs. 6.21 ± 1.05 and 5.83 ± 1.09 Nm/kg at 60° and 120° per second, respectively, P < 0.001). In patients with unilateral sciatica, there was no significant difference (P > 0.05) in unilateral knee strength between sciatica-involved and -uninvolved limbs (1.89 ± 0.5, 1.08 ± 0.45, 1.48 ± 0.58, 0.93 ± 0.41 vs. 1.68 ± 0.45, 0.91 ± 0.38, 1.41 ± 0.48, 0.79 ± 0.39 Nm/kg in sciatica-uninvolved vs. sciatica-involved limbs during extension and flexion at 60° and 120° per second, respectively). Total trunk strength was significantly correlated with total knee strength in both groups. Conclusions. In the patients with lumbar disc herniation, muscle strength of the trunk and knees was decreased to a similar extent. Weaker knee strength was found on either side of the lower extremity in the patients with unilateral sciatica, regardless of its location.

Resolution of Intractable Hiccups after Near-Infrared Irradiation of Relevant Acupoints

Background:Intractable hiccups are occasionally encountered in the presence of stroke but are usually difficult to manage. Methods:We describe two stroke patients with intractable hiccups that were refractory to pharmacological treatment but were well resolved by application to relevant acupoints with the modality linear polarized near-infrared ray equipment on PC 6 (Nei Guan), ST 36 (Zu San Li), and DU 9 (Chih Yang), which are the empirical acupoints aimed at regulating gastrointestinal mobility and function of the thoracic organ. Results:The first patient who received the treatment for only one time came out with a dramatic termination of intractable hiccups 3 hours later and with no recurrence thereafter. We applied the same treatment on the second patient once a day for 8 consecutive days, which led to progressive amelioration of intractable hiccups. Conclusions:This is the first report about the complete resolution of intractable hiccups due to stroke using near-infrared irradiation to acupoints, rather than using conventional pharmacologic therapy, traditional acupuncture, or moxibustion. Consequently, these findings suggest that linear polarized near-infrared ray irradiation, with its noninvasive properties, might be an alternative treatment for intractable hiccups after stroke.

Effect of Radial Shock Wave Therapy on Spasticity of the Upper Limb in Patients With Chronic Stroke: A Prospective, Randomized, Single Blind, Controlled Trial

AbstractRecently, studies have reported that extracorporeal shock wave therapy (ESWT) is a safe, noninvasive, alternative treatment for spasticity. However, the effect of ESWT on spasticity cannot be determined, because most studies to date have enrolled small patient numbers and have lacked placebo-controlled groups and/or long-term follow-up. In addition, whether varying the number of ESWT sessions would affect the duration of the therapeutic effect has not been investigated in a single study. Hence, we performed a prospective, randomized, single blind, placebo-controlled study to investigate the long-term effect of radial ESWT (rESWT) in patients with poststroke spasticity and surveyed the outcome of functional activity.Sixty patients were randomized into 3 groups. Group A patients received 1 session of rESWT per week for 3 consecutive weeks; group B patients received a single session of rESWT; group C patients received one session of sham rESWT per week for 3 consecutive weeks. The primary outcome was Modified Ashworth Scale of hand and wrist, whereas the secondary outcomes were Fugl-Meyer Assessment of hand function and wrist control. Evaluations were performed before the first rESWT treatment and immediately 1, 4, 8, 12, and 16 weeks after the last session of rESWT.Compared to the control group, the significant reduction in spasticity of hand and wrist lasted at least 16 and 8 weeks in group A and B, respectively. Three sessions of rESWT had a longer-lasting effect than one session. Furthermore, the reduction in spasticity after 3 sessions of rESWT may be beneficial for hand function and wrist control and the effect was maintained for 16 and 12 weeks, respectively.rESWT may be valuable in decreasing spasticity of the hand and wrist with accompanying enhancement of wrist control and hand function in chronic stroke patients.

Massage-Induced Brachial Plexus Injury

Background and Purpose There are few reports in the literature of adverse effects resulting from massage therapy (MT) and no reports of brachial plexus injury (BPI) associated with MT. This case report describes an uncommon case of BPI that developed after a session of MT and reviews previously published reports of peripheral nerve injury following MT. Case Description A 58-year-old Asian woman developed sudden unilateral paralysis of her left shoulder girdle after a session of MT. A diagnosis of acute BPI was suspected due to her recent history and the results of several examinations. The results of electrodiagnostic studies indicated a possible location for the lesion and ultimately led to a different diagnosis. Outcomes The patient regularly participated in a twice-weekly rehabilitation program targeting the left shoulder. The rehabilitation program included supervised passive range of motion, strengthening, and stretching exercises as well as a home exercise program. A 12-month follow-up showed the patient had achieved gradual recovery of shoulder strength, resolution of limitations of range of motion, and relief of shoulder pain. Discussion This is believed to be the first report of BPI associated with MT. This case report serves as a reminder to massage therapists and physical therapists that MT of the neck should be carefully performed to avoid injury. Further studies will help design safer and more effective MT for the future.

Cigarette smoking dose as a predictor of need for surgical intervention in patients with lumbar disk herniation

Purpose: Numerous studies have investigated the significant relationship between sciatic pain, radiating lower back pain, lumbosacral radicular syndrome or other disk disorders and cigarette smoking; however, only few reports have demonstrated the relationship between the total smoking dose and lumbar disk herniation (LDH), a cause of lower back or sciatic pain. Furthermore, the relationship between total cigarette consumption and the need of surgical intervention for LDH has not yet been investigated. Materials and Methods: This study included 391 patients with symptomatic LDH. The control group comprised 431 inpatients admitted for other medical or surgical problems. Their demographic data and level of cigarette consumption were obtained through a chart review. The association between lumbar surgical intervention and the clinical characteristics were investigated by multiple logistic regression analyses, with stepwise selection. Results: Compared with the nonsmokers, the smokers had a 1.5-fold increased risk of developing LDH ( P = 0.01). An increased total smoking dose (pack-years) was a risk factor of undergoing lumbar surgical intervention among the LDH patients (odds ratio [OR] = 1.02; P = 0.03). Furthermore, the risk of undergoing lumbar surgical intervention increased to 1.83 times among LDH patients with a 6-10-year smoking history and to 2.16 times among those with >10-year smoking history ( P = 0.02 and P = 0.002, respectively). Conclusion: This study found that the total cigarette smoking dose was associated with LDH and was a risk factor for undergoing surgical intervention for LDH.

Methylprednisolone worsening neuropathic pain in non-traumatic thoracic myelopathy

Methylprednisolone (MP) is the only neuroprotective medication currently in widespread use for the treatment of spinal cord injury. Increasingly, published studies challenge its clinical effects in view of its serious side‐effects including wound infection, pneumonia, sepsis and steroid myopathy. Most cases with spontaneous spinal epidural haematoma (SSEH) need emergency evacuation, and typically show good neurologic recovery. Some patients with SSEH given preoperative or postoperative MP within hours of the onset of symptoms, and have had good motor recovery, although no mention was made of sensory function. Severe, intractable neuropathic pain has not been reported in patients with SSEH.

Multicentric giant cell tumours in an adolescent with haemophilia.

Summary.  ‘‘Multicentric giant cell tumour (GCTs) of the extremity is prone to be distributed over the age range of 20–40 years, but is rare in haemophilia and in the age before 20. We report a case of a 15‐year‐old haemophilia boy who presented initially with two radiolucent loci in the right femur and tibia revealed from the X‐ray films and then another lesion in the posterior femoral shaft shown from MRI by one year. Differential diagnosis of GCTs should be appraised in various aspects. Radiological diagnostic pitfall was avoided by the pathology disclosed GCTs without malignancy. The early diagnosis of GCTs in haemophilia may be delayed unless appearance of symptoms of pathologic fracture. Coincident multicentric GCTs do occur in haemophilic patients and their incidence might be underestimated, as it might not be judged because immediate symptoms of pain would resolve with appropriate factor replacement.”

Analysis of trunk rolling in Parkinson's disease patients using a mattress mobility detection system

BACKGROUND AND OBJECTIVE Parkinsons disease (PD) is a neurodegenerative condition characterized by motor dysfunction and various types of non-motor impairments. The reaction time and movement time are reported to become more severe delayed in worse PD patients. Most tools for evaluating motor impairment are limited by relying on subjective observations and being qualitative in design. The aim of this study was to investigate trunk rolling performance in PD patients by using a recently developed system to detect turning in bed. METHODS The study included 20 PD patients and 42 healthy controls. A mattress mobility detection system was employed for quantitative measurements. Each test session consisted of subjects starting by lying in a supine position on a bed and rolling 10 times onto their left side and 10 times onto their right side. Strain gauges mounted under the feet of the bed recorded changes in the center of pressure (CoP). RESULTS For turning back, the patients compared with the controls had significantly longer movement time (P = 0.017), longer time to peak counteraction (P = 0.001), larger ratio of peak counteraction to movement time (P = 0.006), shorter CoP displacement (P < 0.0001), slower turning speed (P = 0.000), weaker peak counteraction (P = 0.013), and smaller ratio of peak counteraction to weight (P = 0.032). Results for turning over were similar except there was no significant difference in the ratio of peak counteraction to weight. CONCLUSIONS The mattress mobility detection system was useful for objectively assessing trunk rolling performance of PD patients. Improved assessment of trunk function in PD patients could lead to better treatments and improved rehabilitation procedures.

Feasibility of a smartphone-based balance assessment system for subjects with chronic stroke

BACKGROUND Stroke is a cerebral artery disease that may lead to long-term disabilities or death. Patients that survive a stroke usually suffer balance impairments, which affect their performance in activities of daily living (ADLs) and quality of life (QoL). In recent years, smartphones have become very popular and have many capabilities. Smartphone built-in sensors have shown their ability and potential in balance performance assessment. However, the feasibility of smartphones on subjects with chronic strokes remains to be proved. Therefore, the purpose of this study is to evaluate the feasibility of a smartphone-based balance assessment system for subjects with chronic stroke. METHODS Ten subjects with chronic stroke and thirteen healthy adults were recruited in the study. The smartphone HTC 10 (HTC Corporation, Taiwan) was used to perform the balance assessment, and its built-in accelerometer and gyroscope were used to record data from the subjects. Six postures were tested for thirty seconds each: shoulder-width stance (SWS) with eyes opened (E/O) and eyes closed (E/C), feet-together stance (FTS) with E/O and E/C, and semi-tandem stance (STS) with E/O and E/C. The smartphone was fixed to the back of subjects at the second sacral spine (S2) level. The changes registered in the accelerometer and gyroscope data were used to represent the balance performance, in which higher values indicate more instability. Data was analyzed using the independent t-test with the software SPSS 20, and the statistical significance level was set to α < 0.05. RESULTS AND DISCUSSION Significant difference in the acceleration data was found among subjects with chronic stroke and healthy adults under four assessment postures: SWS with E/C (p = 0.048), FTS with E/O (p = 0.027), FTS with E/C (p = 0.000), and STS with E/C (p = 0.048). Furthermore, according to the gyroscope data, there were significant differences in how the two groups performed the postures. The results demonstrate that a smartphone with a built-in accelerometer and gyroscope can be used to classify balance performances between healthy adults and subjects with chronic stroke. CONCLUSION This study shows that smartphones are feasible to assess balance for subjects with chronic stroke.

INFLUENCE OF THREE DIFFERENT CURVATURES FLEX-FOOT PROSTHESIS WHILE SINGLE-LEG STANDING OR RUNNING: A FINITE ELEMENT ANALYSIS STUDY

Flex foot device was one of the most common prosthesis for the athletes with the transtibial amputation on the recent market. Thus, the results of investigation with biomechanics on the flex foot would be a considerable impact on the performance of disabled athletes wearing the flex foots. This study was designed to investigate the biomechanical condition of the flex foot prosthesis with different curvatures while standing and running by finite element analysis. This study demonstrated finite element models of flex foot established with three different curvatures 20∘ (small bending), 35∘ (medium bending) and 50∘ (big bending). Besides, it simulates and investigates the condition of flex foot while a person is wearing it with single-leg standing or running. The evaluation indices were selected as von Mises stress and displacements at top of socket surface. The results show that the big-bending flex foot generated the higher stress and the larger deformed displacement. Without exceeding the material tolerance of the flex foot, the larger displacement of big-bending flex foot could generate more energy, which possessed larger resilient potential energy and enabled the athletes to have better performance after using the flex foot. As a result, due to its beneficial property of energy storage and return, the large-bending flex foot user could have better effect. In the future, more innovative designs of the flex foot prosthesis can be laid out with the reference of the result in this study.